The Role of the Gut Microbiota in Ulcerative Colitis

The aims of the multi-center Ulcerative Colitis Human Microbiome Project (UCHMP) are to examine the role of the enteric microbiome in causing human ulcerative colitis, specifically the development of pouchitis. Pouchitis is an inflammatory condition of the surgically-created ileoanal pouch that serves as a pseudo-rectum in patients with ulcerative colitis who have undergone a total colectomy. It is a condition unique to ulcerative colitis (UC), as it rarely occurs in non-UC patients who have the same procedure. Within one year, about 50% of patients will develop pouchitis. The condition is almost certainly due to aspects of the pouch microbiota on a background of genetic susceptibility, as most patients respond to treatment with antibiotics. While there have been reports on the microbiota in pouchitis patients, all have been performed after the inflammatory process is initiated, rendering interpretation of the results difficult, as the inflammatory process itself will change the microbiota. Our project is therefore unique and possibly the only opportunity in the role of the enteric microbiome in IBD in a prospective manner, thereby establishing potentially important causal relationships between microbiota structure or function and development of UC.The studies also offer two additional advantages. First, the development of the pouch microbiota can be observed prospectively. Second, the cause of antibiotic treatment failure in some patients with pouchitis may be revealed. The two aims are (1) to identify causal factors in the structure and/or function of the enteric microbiota in the development of pouchitis, and (2) to determine the basis of treatment failure in UC pouchitis patients. Our analyses will include serial measurements of enteric microbial structure (16S rRNA gene-based), function (metagenomics and functional candidate genes), and cultivation, the latter to enhance interpretation of gene sequences derived from metagenomes and targeted gene surveys (either functional or 16S genes). The insights gained from these studies will help us understand the fundamental and causative roles of the enteric microbiome in human inflammatory bowel diseases (IBD). This information will be the basis for developing strategies to restore host-microbial relationships to prevent and treat IBD.]]>
Role of Microbiota in the Pathogenesis of PouchitisCONSENT BY SUBJECT FOR PARTICIPATION IN A RESEARCH PROTOCOL (ACUTE)CONSENT BY SUBJECT FOR PARTICIPATION IN A RESEARCH PROTOCOL (MAIN)Source Documents, Initial Visit, AcuteSource Documents, Initial Visit, LongitudinalSource Documents, Return VisitInclusion Criteria: Age greater than or equal to 18 years Confirmed diagnosis of ulcerative colitis Subject scheduled for a total proctocolectomy with ileal pouch anal anastomosis The patient is willing and able to sign the written, informed consent document Exclusion Criteria: Female patients who are pregnant The patient appears to be uncooperative or not dependable for any reason Patients unable to give informed consent ]]>
September 2009 - First patient enrolled in acute pouchitis arm October 2009 - First patient enrolled in longitudinal arm ]]>